Optimization of application of current

ABSTRACT

An excitation unit is configured to induce action potentials by applying an excitatory current to a nerve. A blocking unit is configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve. A sensor unit is configured to detect the induced action potentials in the nerve, and to responsively provide a sensor signal that conveys information about the detected induced action potentials. Circuitry is configured (i) to drive the excitation unit to apply the excitatory current, (ii) to drive the blocking unit to apply the blocking current, (iii) while driving the blocking unit to apply the blocking current, to drive the sensor unit to detect the induced action potentials and provide the sensor signal, (iv) to receive the sensor signal, and (v) in response to the sensor signal, to alter a parameter of the blocking current.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a Continuation of U.S. Ser. No. 14/935,941 to Oron et al., filed Nov. 9, 2015, and entitled “Optimization of application of current,” which published as US 2017/0128724.

The present application is related to the following applications, all of which are assigned to the assignee of the present application, and all of which are incorporated herein by reference:

U.S. patent application Ser. No. 14/374,375 to Gross et al., entitled “Wireless neurostimulators,” which published as US 2015/0018728 (now abandoned);

U.S. patent application Ser. No. 14/601,626 to Oron et al., filed Jan. 21, 2015, and entitled “Extracorporeal implant controllers” (now U.S. Pat. No. 9,764,146); and

U.S. patent application Ser. No. 14/601,568 to Plotkin et al., filed Jan. 21, 2015, and entitled “Transmitting coils for neurostimulation” (now U.S. Pat. No. 9,597,521).

FIELD OF THE INVENTION

Some applications of the present invention relate in general to medical devices. More specifically, some applications of the present invention relate to percutaneous neurostimulator implants.

BACKGROUND

Neurostimulation is a clinical tool used to treat various neurological disorders. This technique involves modulation of the nervous system by electrically activating fibers in the body. Percutaneous implants exist for providing neurostimulation. Powering such implants is a technical challenge.

SUMMARY OF THE INVENTION

Systems described herein comprise a blocking unit that is configured to block undesired endogenous action potentials, typically afferent action potentials that cause an unpleasant or painful sensation, e.g., due to neuropathy.

Calibration of nerve-blocking devices is useful because the parameters of the blocking current required for effective blocking of action potentials may differ between individual subjects themselves, and/or due to differences in the position and orientation of the device, e.g., with respect to the target nerve. Furthermore, for devices that comprise an implant, movement of the implant (e.g., long-term migration, or short-term movement due to movement of the subject) may also affect the optimal parameters of the blocking current.

Several of the techniques described herein involve calibrating the nerve-blocking device, facilitated by artificially-induced action potentials, thereby overcoming the problem described above. For some of these techniques, the artificially-induced action potentials are detected by a sensor unit, and calibration is automated. For some techniques, the calibration is manual. For some applications of the invention, calibration is performed only before treatment (e.g., by a physician). For some applications of the invention, calibration is performed regularly (e.g., several times per week, day or hour).

There is therefore provided, in accordance with an application of the present invention, apparatus, for use with a nerve of a subject, the apparatus including:

an implantable excitation unit, configured to induce action potentials in the nerve by applying an excitatory current to the nerve;

an implantable blocking unit, configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve; and

an extracorporeal controller, including (i) at least one antenna, and (ii) circuitry configured:

-   -   to wirelessly drive the excitation unit to apply the excitatory         current,     -   in a first mode of the extracorporeal controller, to wirelessly         drive the blocking unit to apply the blocking current while not         driving the excitation unit to apply the excitatory current,     -   in a second mode of the extracorporeal controller, to wirelessly         drive the blocking unit to apply the blocking current while         driving the excitation unit to apply the excitatory current, and     -   to wirelessly alter a parameter of the blocking current, based         on sensing performed while the extracorporeal controller is in         the second mode.

In an application, the circuitry is configured to automatically periodically switch the extracorporeal controller between the first and second modes.

In an application, the apparatus further includes an implant that includes a housing that houses the excitation unit and the blocking unit.

In an application, the circuitry is configured, in a third mode of the extracorporeal controller, to wirelessly drive the excitation unit to apply the excitatory current while not driving the blocking unit to apply the blocking current.

In an application, the excitatory current has a frequency of 2-400 Hz, and the circuitry is configured to wirelessly drive the excitation unit to apply the excitatory current having the frequency of 2-400 Hz.

In an application, the excitatory current has a frequency of 5-100 Hz, and the circuitry is configured to wirelessly drive the excitation unit to apply the excitatory current having the frequency of 5-100 Hz.

In an application, the blocking current has a frequency of 1-20 kHz, and the circuitry is configured to wirelessly drive the blocking unit to apply the blocking current having the frequency of 1-20 kHz.

In an application, the blocking current has a frequency of 3-10 kHz, and the circuitry is configured to wirelessly drive the blocking unit to apply the blocking current having the frequency of 3-10 kHz.

In an application, the apparatus further includes an implantable sensor unit, configured to detect the induced action potentials in the nerve, and to responsively provide a sensor signal that conveys information about the detected induced action potentials, and the circuitry of the extracorporeal controller is configured to wirelessly receive the sensor signal, and to alter the parameter of the blocking current in response to the received sensor signal.

In an application, the apparatus further includes an implant that includes a housing that houses the excitation unit, the blocking unit, and the sensor unit.

In an application, the circuitry is configured to automatically periodically run a calibration routine including:

(a) switching the extracorporeal controller into the second mode,

(b) receiving the sensor signal, the sensor signal conveying information about induced action potentials detected while the extracorporeal controller is in the second mode,

(c) in response to the sensor signal received in step (b) of the calibration routine, altering the parameter of the blocking current, and

(d) switching the extracorporeal controller into the first mode.

In an application, the circuitry is configured, in a third mode of the extracorporeal controller, to wirelessly drive the excitation unit to apply the excitatory current while not driving the excitation unit to apply the blocking current, and the calibration routine further includes, prior to step (a):

(i) switching the extracorporeal controller into the third mode, and

(ii) receiving the sensor signal, the sensor signal conveying information about induced action potentials detected while the extracorporeal controller is in the third mode.

In an application, step (c) of the calibration routine includes altering the parameter of the blocking current in response to the sensor signal received in step (b) of the calibration routine, and in response to the sensor signal received in step (ii) of the calibration routine.

In an application, the extracorporeal controller further includes a user interface, and the circuitry is configured to wirelessly alter the parameter of the blocking current in response to user operation of the user interface.

In an application, the circuitry is configured to switch the extracorporeal controller between the first and second modes in response to user operation of the user interface.

There is further provided, in accordance with an application of the present invention, apparatus for use with a nerve of a subject, the apparatus including:

an excitation unit, configured to induce action potentials in the nerve by applying an excitatory current to the nerve;

an implantable blocking unit, configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve;

an implantable sensor unit, configured to detect the induced action potentials in the nerve, and to responsively provide a sensor signal that conveys information about the detected induced action potentials; and

circuitry configured:

-   -   to drive the excitation unit to apply the excitatory current,     -   to drive the blocking unit to apply the blocking current,     -   while driving the blocking unit to apply the blocking current,         to drive the sensor unit to detect the induced action potentials         and provide the sensor signal,     -   to receive the sensor signal, and     -   in response to the sensor signal, to alter a parameter of the         blocking current.

In an application, the apparatus further includes an extracorporeal controller that includes the circuitry, and is configured to wirelessly drive the excitation unit, the blocking unit, and the sensor unit, and to wirelessly receive the sensor signal.

In an application, the sensor signal is a wireless sensor signal, and the circuitry is configured to wirelessly receive the sensor signal.

In an application, the circuitry is configured to drive the excitation unit wirelessly, and to drive the blocking unit wirelessly.

In an application, the excitation unit is configured to elicit paresthesia by applying the excitatory current.

In an application, the excitation unit is configured to elicit pain by applying the excitatory current.

In an application, the circuitry is configured to automatically periodically run a calibration routine including:

(a) switching from (i) a first mode in which the circuitry drives the blocking unit to apply the blocking current while not driving the excitation unit to apply the excitatory current, into (ii) a second mode in which the circuitry drives the blocking unit to apply the blocking current while driving the excitation unit to apply the blocking current,

(b) while in the second mode, driving the sensor unit to detect the induced action potentials and provide the sensor signal,

(c) in response to the sensor signal received in (b), altering the parameter of the blocking current, and

(d) switching back into the first mode.

In an application, the circuitry is configured:

to drive the blocking unit by providing a blocking-command signal having an energy consumption; and

in response to the sensor signal conveying information indicative of a reduction of detected induced action potentials, to reduce the energy consumption of the blocking-command signal.

In an application, the blocking unit is disposed between the excitation unit and the sensor unit.

In an application, the excitation unit is an implantable excitation unit.

In an application, the excitatory current has a lower frequency than that of the blocking current, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the lower frequency.

In an application, the excitatory current has a frequency of 2-400 Hz, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the frequency of 2-400 Hz.

In an application, the excitatory current has a frequency of 5-100 Hz, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the frequency of 5-100 Hz.

In an application, the blocking current has a frequency of 1-20 kHz, and the circuitry is configured to drive the blocking unit to apply the blocking current having the frequency of 1-20 kHz.

In an application, the blocking current has a frequency of 3-10 kHz, and the circuitry is configured to drive the blocking unit to apply the blocking current having the frequency of 3-10 kHz.

In an application, the apparatus further includes an implant that includes the excitation unit, the blocking unit, and the sensor unit.

In an application, the apparatus further includes an extracorporeal controller that includes the circuitry, and is configured to wirelessly drive the excitation unit, the blocking unit, and the sensor unit, and to wirelessly receive the sensor signal.

In an application, the implant further includes the circuitry.

In an application, the implant is injectable.

In an application, the implant is dimensioned to be injectable into an epidural space of a subject.

In an application, the implant is configured to be implanted at the nerve such that the sensor unit is disposed at a first nerve site, and the blocking unit is disposed at a second nerve site that is efferent to the first nerve site.

In an application:

the implant has a longitudinal axis,

the blocking unit is 0.5-5 cm along the longitudinal axis from the excitation unit, and

the sensor unit is 0.5-5 cm along the longitudinal axis from the blocking unit.

There is further provided, in accordance with an application of the present invention, apparatus, for use with a nerve of a subject, the apparatus including:

an implant, having a longitudinal axis, injectable into the subject along the longitudinal axis, and including:

-   -   an elongate housing having a first half including a first end,         and a second half including a second end;     -   at least one paresthesia-inducing electrode disposed on a first         site of the housing within the first half;     -   at least one blocking electrode disposed on a second site of the         housing within the second half; and     -   circuitry, having:         -   a first mode in which the circuitry simultaneously             drives (i) the at least one paresthesia-inducing electrode             to apply a paresthesia-inducing current having a frequency             of 2-400 Hz, and (ii) the at least one blocking electrode to             apply a blocking current having a frequency of 1-20 kHz, and         -   a second mode in which the circuitry (i) drives the at least             one blocking electrode to apply the blocking current,             but (ii) does not drive the at least one             paresthesia-inducing electrode to apply the             paresthesia-inducing current.

The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-4 are schematic illustrations of systems for use with a nerve of a subject, in accordance with some applications of the invention;

FIGS. 5-10 are schematic illustrations illustrating the operation of the systems, in accordance with some applications of the invention; and

FIGS. 11-12 are schematic illustrations of a system for use with a nerve of a subject, and operation of the system, in accordance with some applications of the invention.

DETAILED DESCRIPTION OF EMBODIMENTS

Systems described herein, comprise a blocking unit that is configured to block undesired endogenous action potentials, typically afferent action potentials that cause an unpleasant or painful sensation, e.g., due to neuropathy. For some applications, this is the primary function of the system.

Calibration of nerve-blocking devices is useful because the parameters of the blocking current required for effective blocking of action potentials may differ between individual subjects themselves, and/or due to differences in the position and orientation of the device, e.g., with respect to the target nerve. Furthermore, for devices that comprise an implant, movement of the implant (e.g., long-term migration, or short-term movement due to movement of the subject) may also affect the optimal parameters of the blocking current.

Typically, calibration of a nerve-blocking device is performed based on feedback from the subject regarding whether a reduction in the unpleasant/painful sensation has been achieved. Often, the sensation being treated is not continuous or constant, and may fluctuate based on time of day, position and/or activity of the subject, and/or other factors. This can make such calibration difficult. Several of the techniques described herein involve calibrating the nerve-blocking device, facilitated by artificially induced action potentials, thereby overcoming the problem described above.

Reference is made to FIGS. 1-4, which are schematic illustrations of systems 40, 60, 80 and 100 for use with a nerve of a subject, in accordance with some applications of the invention. Each of systems 40, 60, 80 and 100 comprises (i) an implantable excitation unit, configured to induce action potentials in the nerve by applying an excitatory current to the nerve, (ii) an implantable blocking unit, configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve, (iii) an implantable sensor unit, configured to detect the induced action potentials, and (iv) circuitry configured, inter aLia, to drive the excitation unit, the blocking unit, and the sensor unit. Each of systems 40, 60 and 80 further comprises an extracorporeal controller that wirelessly powers the excitation unit, the blocking unit, and the sensor unit. The extracorporeal controller of systems 40 and 60 further comprise the circuitry that is configured to drive the excitation unit, the blocking unit, and the sensor unit, whereas in system 80 that circuitry is implantable, and the extracorporeal controller wirelessly provides only power. In system 100, power is provided by an implanted battery, and there is no extracorporeal controller.

The excitation unit, the blocking unit, and the sensor unit each comprise one or more electrodes, and each is therefore configured to interface electrically with the subject. The excitation unit applies the excitatory current via its one or more electrodes, the blocking unit applies the blocking current via its one or more electrodes, and the sensor unit detects the induced action potentials via its one or more electrodes.

Typically, the blocking current has a frequency of greater than 1 kHz, and/or less than 20 kHz (e.g., 1-20 kHz, e.g., 1-10 kHz, such as 3-10 kHz).

Typically, the excitatory current has a frequency of greater than 2 Hz and/or less than 400 Hz (e.g., 2-400 Hz, e.g., 2-300 Hz, e.g., 2-200 Hz, e.g., 2-100 Hz, e.g., 5-100 Hz, e.g., 5-40 Hz). For some applications, the excitatory current includes bursts of higher-frequency such as up to 1200 Hz. Typically, the excitatory current has a frequency that is lower than that of the blocking current. Typically, the excitatory current is configured to induce action potentials that, at least in the absence of the blocking current, are experienced by the subject, e.g., as a sensation such as paresthesia or pain. For some applications, the excitatory current is configured to induce action potentials that are not experienced by the subject (e.g., as a sensation).

The excitation unit of each system is configured to induce afferent action potentials, which are detected by the sensor unit. The sensor unit provides (wirelessly or wiredly) a sensor signal that conveys information about the detected action potentials (e.g., their magnitude and/or frequency). The circuitry of the system is configured to receive the sensor signal, and to responsively alter a parameter of the blocking current, such as amplitude, frequency or duty cycle. Thereby, the circuitry establishes the effectiveness of the blocking unit and/or blocking current at blocking the induced action potentials, and calibrates the blocking current to an effective but not excessive level, thereby optimizing power consumption, as well as the amount of current received by the subject.

FIGS. 1-4 show the respective system with respect to a nerve 10 and skin 12 of a subject. The labels “AFFERENT” and “EFFERENT” indicate the orientation of the neural anatomy. Nerve 10 is typically a peripheral nerve. For some applications nerve 10 is a spinal nerve. For some applications nerve 10 is nervous tissue of the spinal cord, and the implant(s) are implanted in (e.g., injected into) the epidural space.

FIG. 1 shows system 40, which comprises (i) an implantable excitation unit 22, configured to induce action potentials in the nerve by applying an excitatory current to the nerve, (ii) an implantable blocking unit 24, configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve, (iii) an implantable sensor unit 26, configured to detect the induced action potentials, and (iv) circuitry 50 configured, inter aLia, to drive the excitation unit, the blocking unit, and the sensor unit.

System 40 comprises (i) an excitation implant 42 that comprises excitation unit 22, as well as an intracorporeal antenna 28 (labeled 28 a), (ii) a blocking implant 44 that comprises blocking unit 24, as well as an intracorporeal antenna 28 (labeled 28 b), and (iii) a sensor implant 46 that comprises sensor unit 26, as well as an intracorporeal antenna 28 (labeled 28 c). Typically, each of the implants comprises a housing that houses the respective unit. The implants are typically implanted in the vicinity (e.g., within 10 mm, such as within 7 mm) of nerve 10. The implants are implanted such that, as shown, implant 46 is afferent to implant 44, and implant 44 is afferent to implant 42 (and therefore unit 26 is afferent to unit 24, and unit 24 is afferent to unit 22). Typically, implants 42, 44 and 46 are implanted by injection, and may be implanted independently or using a single injection device.

For some applications, implant 46 is implanted 1-10 cm (e.g., 2-5 cm) away from implant 44, and implant 44 is implanted 1-10 cm (e.g., 2-5 cm) away from implant 42.

System 40 further comprises an extracorporeal controller 48 that comprises circuitry 50, as well as an extracorporeal antenna 32 and a battery 34 that powers the circuitry. (It is to be understood that antenna 32 may comprise one or more antennas.) Circuitry 50 is configured to wirelessly drive (e.g., to wirelessly power and operate) excitation unit 22, blocking unit 24, and sensor unit 26, via antenna 32 and antennas 28. Units 22, 24 and 26 (e.g., implants 42, 44 and 46) are independently addressable by extracorporeal controller 48 (e.g., by circuitry 50 thereof). For example, a wireless power signal having a particular characteristic (e.g., frequency) may be used when a particular unit is to be driven, and only that unit is powered by that power signal (e.g., only the antenna of the implant of that unit is configured to receive that power signal). Similarly, a code may be modulated onto the power signal.

The operation of system 40 (as well as that of systems 60, 80 and 100) will be described hereinbelow (e.g., with reference to FIGS. 5-10).

FIG. 2 shows system 60, which comprises excitation unit 22, blocking unit 24, sensor unit 26, and circuitry 70 configured, inter aLia, to drive the excitation unit, the blocking unit, and the sensor unit.

System 60 comprises an implant 62 that comprises excitation unit 22, blocking unit 24, and sensor unit 26, as well as an intracorporeal antenna 28 (labeled 28 d). Typically, implant 62 comprises a housing 64 that houses units 22, 24 and 26, and antenna 28 d. Housing 64 is typically elongate. Typically, implant 62 is implanted in the vicinity (e.g., within 10 mm, such as within 7 mm) of nerve 10, e.g., such that a longitudinal axis of the implant is aligned with the nerve. Implant 62 is implanted such that unit 26 is afferent to unit 24, and unit 24 is afferent to unit 22. Typically, implant 62 is implanted by injection.

For some applications, implant 62 is dimensioned such that unit 26 (e.g., the electrode(s) thereof) is 0.5-5 cm (e.g., 1-2 cm) away from unit 24 (e.g., the electrode(s) thereof). For some applications, implant 62 is dimensioned such that unit 24 (e.g., the electrode(s) thereof) is 0.5-5 cm (e.g., 1-2 cm) away from unit 22 (e.g., the electrode(s) thereof).

System 60 further comprises an extracorporeal controller 68 that comprises circuitry 70, as well as extracorporeal antenna 32 and battery 34 that powers the circuitry. Circuitry 70 is configured to wirelessly drive (e.g., to wirelessly power and operate) excitation unit 22, blocking unit 24, and sensor unit 26, via antenna 32 and antenna 28 d. Units 22, 24 and 26 are independently addressable by extracorporeal controller 68 (e.g., by circuitry 70 thereof). For example, a code may be modulated onto the wireless power signal, and implant 62 may comprise implant circuitry 66 (e.g., comprising a switch), which directs the received power to the appropriate unit in response to the code. Alternatively, implant 62 may comprise a separate antenna for each of units 22, 24 and 26 (e.g., as shown for system 20, mutatis mutandis), and the wireless power signal is configured to have a particular characteristic (e.g., frequency) that only a particular antenna is configured to receive.

Therefore, for some applications of the invention, system 60 is similar to system 20, except that units 22, 24 and 26 are housed within a single implant, rather than within separate implants.

The operation of system 60 (as well as that of systems 40, 80 and 100) will be described hereinbelow (e.g., with reference to FIGS. 5-10).

FIG. 3 shows system 80, which comprises excitation unit 22, blocking unit 24, sensor unit 26, and circuitry 90 configured, inter alia, to drive the excitation unit, the blocking unit, and the sensor unit.

System 80 comprises an implant 82 that comprises excitation unit 22, blocking unit 24, and sensor unit 26, as well as an intracorporeal antenna 28 (labeled 28 e). In this regard, system 80 is identical to system 60. However, whereas in system 60 (and system 40) the circuitry that drives units 24, 26 and 28 is within an extracorporeal controller, in system 80 implant 82 comprises circuitry 90. That is, circuitry 90 is implant circuitry. Typically, implant 82 comprises a housing 84 that houses units 22, 24 and 26, antenna 28 e, and circuitry 90. Housing 84 is typically elongate. Typically, implant 82 is implanted in the vicinity (e.g., within 10 mm, such as within 7 mm) of nerve 10, e.g., such that a longitudinal axis of the implant is aligned with the nerve. Implant 82 is implanted such that unit 26 is afferent to unit 24, and unit 24 is afferent to unit 22. Typically, implant 82 is implanted by injection.

System 80 further comprises an extracorporeal controller 88 that comprises extracorporeal antenna 32 and battery 34. Whereas in systems 40 and 60, the extracorporeal controller (e.g., circuitry thereof) drives units 22, 24 and 26, in system 80 controller 88 merely provides wireless power to implant 82 via antennas 32 and 28 e. That is, controller 88 wirelessly powers circuitry 90, which drives (e.g., operates, typically wiredly) units 22, 24 and 26. Units 22, 24 and 26 are independently addressable by circuitry 90.

Therefore, for some applications of the invention, system 80 is similar to system 60, except that the circuitry that drives units 24, 26 and 28 is within the implant, rather than within the extracorporeal controller.

The operation of system 80 (as well as that of systems 40, 60 and 100) will be described hereinbelow (e.g., with reference to FIGS. 5-10).

FIG. 4 shows system 100, which comprises excitation unit 22, blocking unit 24, sensor unit 26, and circuitry 110 configured, inter aLia, to drive the excitation unit, the blocking unit, and the sensor unit.

System 100 comprises an implant 102 that comprises excitation unit 22, blocking unit 24, and sensor unit 26, and similarly to implant 82, circuitry 110 is implant circuitry. However, whereas in system 80, power is provided by an extracorporeal controller that transmits the power wirelessly to an antenna of the implant, in system 100 implant 102 comprises a battery 106. Typically, implant 102 comprises a housing 104 that houses units 22, 24 and 26, circuitry 110 and battery 106. Housing 104 is typically elongate. Typically, implant 102 is implanted in the vicinity (e.g., within 10 mm, such as within 7 mm) of nerve 10, e.g., such that a longitudinal axis of the implant is aligned with the nerve. Implant 102 is implanted such that unit 26 is afferent to unit 24, and unit 24 is afferent to unit 22. Typically, implant 102 is implanted by injection.

Therefore, for some applications of the invention, system 100 is similar to system 80, except that power is provided by a battery within the implant, rather than being wirelessly received from an extracorporeal controller. It is to be noted that despite this distinction, implant 102 (e.g., battery 106 thereof) may be wirelessly rechargeable.

The operation of system 100 (as well as that of systems 40, 60 and 80) will be described hereinbelow (e.g., with reference to FIGS. 5-10).

Reference is again made to FIGS. 1-4. Implants 42, 44, 46, 62 and 82 typically comprise no non-transient power storage element (e.g., battery), although they may comprise capacitors. Similarly, implants 42, 44, 46 and 62 typically comprise only simple circuitry that, in the absence of the extracorporeal controller, is not capable of performing the operations described hereinbelow. Therefore, the extracorporeal controllers described hereinabove are typically present during real-time operation of their respective implant(s). That is, the powering and/or operation of the implant(s) is typically performed by the extracorporeal controller in real-time. Typically, the extracorporeal controllers are attachable to the body of the subject, e.g., using a strap 21, and are sufficiently small and light to be worn for a large proportion of the day.

Reference is made to FIGS. 5-10, which are schematic illustrations illustrating the operation of systems 40, 60, 80 and 100, in accordance with some applications of the invention.

FIG. 5 is a flow diagram of at least some steps of a calibration routine 120 that is performed by the circuitry of systems 40, 60, 80 and 100, in accordance with some applications of the invention. As described hereinabove, the circuitry of each system is configured (i) to drive the excitation unit, the blocking unit, and the sensor unit (step 122), (ii) to receive the sensor signal (step 124), and (iii) in response to the sensor signal, to alter a parameter of (i.e., to calibrate) the blocking current (step 126). The driving of the excitation, blocking and sensor units are shown within a single step 122 because, although (as described with reference to FIGS. 6-9) during routine operation the blocking unit is typically “on” also at times when the excitation and sensor units are “off”, during the calibration routine all three units are driven at the same time (e.g., within 10 ms, such as within 5 ms of each other).

FIGS. 6-10 are schematic graphs that illustrate temporal relationships between the driving of the blocking, excitation, and sensor units, according to various applications of the invention. That is, FIGS. 6-10 illustrate, according to various applications of the invention, temporal relationships between the calibration routine and the treatment mode.

In FIGS. 6-9, coincident driving of the blocking, excitation and sensor units is performed as part of the running of a calibration routine. As described hereinabove, the primary function of the systems described herein is typically blocking of undesired action potentials by the blocking unit. Therefore, during routine operation, the blocking unit is typically “on” also at times when the excitation and sensor units are “off” (even, for example, minutes, hours, or days after the excitation and sensor units were last “on”). FIG. 6 illustrates this, showing constant blocking over a period of time (e.g., an hour, a day, or a week), with periodic calibrations (e.g., every few (e.g., 10) minutes, every hour, or every day). However, as illustrated by FIG. 7, blocking need not always be constant, and periodic cessations in blocking may be provided. FIG. 7 also illustrates that for some such applications, multiple calibrations are performed during the course of each continuous blocking period. FIG. 8 shows that for some applications a single calibration is performed during the course of (e.g., at the start of, in the middle of, or at the end of) each blocking period. FIG. 9 shows that for some applications a calibration is not performed during the course of each blocking period, and that one or more calibration-free blocking periods may be provided between blocking periods in which calibration is performed.

Alternatively or additionally, an initial calibration is performed at the start of treatment (e.g., soon after implantation), e.g., initiated by the physician or other medical practitioner.

As described hereinabove, during the calibration routine the blocking, excitation and sensor units are driven at the same time, so as to detect induced action potentials that aren't successfully blocked by the blocking unit. For some applications, a self-checking step is performed (e.g., as part of the calibration routine, or independently of the calibration routine), so as to ensure that a lack of detected induced action potentials (or a low magnitude of the action potentials) is in fact due to successful blocking, rather than to ineffective induction or detection of action potentials (i.e., ineffective performance of the excitation or sensor unit). In such a self-checking step, both the excitation and sensor units are driven, but the blocking unit is not.

FIG. 10 illustrates an example of such a self-checking step. The excitation and sensor units are switched on just prior to the (re)commencement of blocking, such that for a brief period 140 (e.g., 100 ms-10 s, e.g., 100 ms-5 s, such as 100 ms-2 s) any induced action potentials may continue unimpeded to the sensor unit. In response to detecting action potentials during period 140, the sensor unit provides a sensor signal that conveys information about the detected action potentials (e.g., their magnitude and/or frequency), and the circuitry receives and responds to the sensor signal. For some applications, the brevity of period 140 is important, because such induced action potentials may be experienced by the subject as discomfort, paresthesia, or pain (e.g., similarly to the way that the undesired endogenous action potentials are experienced).

For some applications, in response to the sensor signal from period 140, circuitry of the system alters a parameter of (e.g., reconfigures) the excitatory current and/or reconfigures the sensor unit (e.g., a sensitivity thereof).

For some applications, the circuitry of the system compares the action potentials detected during period 140 with those detected during a period 142 in which the blocking unit is also driven, and reconfigures the excitatory current, sensor unit and/or blocking current in response to this comparison.

For some applications, if the detected action potentials of period 140 are insufficient (e.g., of insufficient magnitude), this is indicated by the extracorporeal control unit, and the implant may be repositioned or removed.

For some applications, in response to the sensor signal from period 140, circuitry of the system alters a parameter of (e.g., reconfigures) the blocking current.

Self-checking may be performed (e.g., period 140 may be provided) once (e.g., at around the time of implantation, such as by the physician), occasionally (e.g., during a routine “service” of the system), regularly (e.g., once per day), or often (e.g., before each calibration routine, e.g., automatically). Self-checking may be performed immediately before or after a calibration routine (e.g., period 140 may be provided immediately before or after period 142), as shown in FIG. 10, or may be performed separately.

Reference is now made to FIGS. 11-12, which are schematic illustrations of a system 160 for use with a nerve of a subject, and operation of the system, in accordance with some applications of the invention. System 160 is typically similar to system 60, except where noted. System 160 comprises excitation unit 22, blocking unit 24, and circuitry 170 configured, inter aLia, to drive the excitation unit and the blocking unit.

System 160 comprises an implant 162 that comprises excitation unit 22 and blocking unit 24, as well as an intracorporeal antenna 28 (labeled 28 f). Typically, implant 162 comprises a housing 164 that houses units 22 and 24, and antenna 28 f. Housing 164 is typically elongate. Typically, implant 162 is implanted in the vicinity (e.g., within 10 mm, such as within 7 mm) of nerve 10, e.g., such that a longitudinal axis of the implant is aligned with the nerve. Implant 162 is implanted such that unit 24 is afferent to unit 22. Typically, implant 162 is implanted by injection.

System 160 further comprises an extracorporeal controller 168 that comprises circuitry 170, as well as extracorporeal antenna 32 and battery 34 that powers the circuitry. Circuitry 170 is configured to wirelessly drive (e.g., to wirelessly power and operate) excitation unit 22 and blocking unit 24, via antenna 32 and antenna 28 f. Units 22 and 24 are independently addressable by extracorporeal controller 168 (e.g., by circuitry 170 thereof). For example, a code may be modulated onto the wireless power signal, and implant 162 may comprise implant circuitry 166 (e.g., comprising a switch), which directs the received power to the appropriate unit in response to the code. Alternatively, implant 162 may comprise a separate antenna for each of units 22 and 24, and the wireless power signal is configured to have a particular characteristic (e.g., frequency) that only a particular antenna is configured to receive.

Therefore, for some applications of the invention, system 160 is similar to system 60, except that it lacks a sensor unit. Controller 168 comprises an interface 172 that typically comprises a display and/or an input such as buttons or a dial. The calibration of the blocking current of system 160 is performed in response to user operation of interface 172. The calibration of the blocking current of system 160 is typically performed manually. Excitation unit 22 is driven by controller 168 in response to user operation of interface 172 (e.g., initiation of the calibration routine). The afferent action potentials induced by excitation unit 22 are experienced by the subject, e.g., as a sensation, discomfort, paresthesia, or pain. While excitation unit continues to initiate these action potentials, blocking unit 24 is driven by controller 168. (The driving of blocking unit 24 may start simultaneously with the driving of excitation unit 22, may start automatically after a delay, or may start upon receiving a separate instruction from user operation of interface 172.) By operating interface 172, the user (e.g., the subject or the physician) manually causes circuitry 170 to wirelessly calibrate the blocking current until the induced action potentials are experienced less strongly (e.g., until they are no longer experienced).

It is to be noted that the scope of the invention includes a system similar to system 160, but with circuitry 170 replaced with implant circuitry (e.g., similar to implant circuitry 90 of system 80, mutatis mutandis). Similarly, the scope of the invention includes a similar system without an extracorporeal controller, and instead with the implant comprising a battery (e.g., similar to system 100, mutatis mutandis).

For some applications, and as shown, excitation unit 22 is disposed within a first half of elongate housing 164 (e.g., a half that includes a first end of the housing), and blocking unit 24 is disposed within a second half of the housing (e.g., a half that includes a second, opposite end of the housing). Therefore, for some applications, an implant is provided that has a longitudinal axis, is injectable into the subject along the longitudinal axis, and comprises:

-   -   (i) an elongate housing having a first half including a first         end, and a second half including a second end;     -   (ii) at least one paresthesia-inducing electrode (i.e., of         excitation unit 22) disposed on a first site of the housing         within the first half;     -   (ii) at least one blocking electrode (i.e., of blocking unit 24)         disposed on a second site of the housing within the second half;         and     -   (iv) circuitry (which may be circuitry 170, or may be implant         circuitry), having:         -   a first mode (e.g., for the calibration routine) in which             the circuitry simultaneously drives (a) the at least one             paresthesia-inducing electrode to apply a             paresthesia-inducing current having a frequency of 2-400 Hz,             and (b) the at least one blocking electrode to apply a             blocking current having a frequency of 1-20 kHz, and         -   a second mode (e.g., a treatment mode) in which the             circuitry (a) drives the at least one blocking electrode to             apply the blocking current, but (b) does not drive the at             least one paresthesia-inducing electrode to apply the             paresthesia-inducing current.

FIG. 12 is a flow diagram of at least some steps of a calibration routine 180 that is performed on system 160, in accordance with some applications of the invention. As described hereinabove, circuitry 170 of system 160 is configured (i) to drive excitation unit 22 and blocking unit 24 (step 182), (ii) to receive input via user operation of user interface 172 (step 184), and (iii) in response to the input, to alter a parameter of (i.e., to calibrate) the blocking current (step 186). The driving of the excitation and blocking units are shown within a single step 182 because, although (as described hereinabove) during routine operation the blocking unit is typically “on” also at times when the excitation unit is “off”, during the calibration routine both units are driven at the same time (e.g., within 10 ms, such as within 5 ms of each other).

The timing of the calibration routine of system 160, with respect to its treatment mode, may follow one or more of those described for systems 40, 60, 80 and 100 (e.g., with reference to FIGS. 6-10), mutatis mutandis. Similarly, self-checking may be performed on system 160, in which excitation unit 22 but not blocking unit 24 is driven.

Reference is again made to FIGS. 1, 2, 5-10, 11 and 12. It is to be noted that, for each of systems 40, 60 and 160, the system comprises:

-   -   (i) implantable excitation unit 22, configured to induce action         potentials in the nerve by applying an excitatory current to the         nerve;     -   (ii) implantable blocking unit 24, configured to block the         induced action potentials from propagating along the nerve by         applying a blocking current to the nerve; and     -   (iii) an extracorporeal controller (e.g., controller 48, 68 or         168), comprising at least one antenna, circuitry (e.g.,         circuitry 50, 70 or 170).

As described hereinabove, the primary function of each system is blocking of undesirable endogenous action potentials. Consequently, in a first mode (e.g., a treatment mode) of the system (e.g., of the extracorporeal controller), the blocking current but not the excitatory current is driven. Typically, at least 90 percent of the time that the blocking current is driven, the excitatory current is not driven. In a second mode (e.g., a calibration mode) of the system (e.g., of the extracorporeal controller), both the blocking and excitatory currents are driven, e.g., for the calibration routine. Typically, only during self-checking is the excitatory current driven in the absence of the blocking current. Typically, even for applications in which self-checking is used, more than 30 percent of the time that the excitatory current is driven, the blocking current is also driven.

The circuitry (e.g., circuitry 50, 70 or 170) is configured:

-   -   (i) to wirelessly drive the excitation unit to apply the         excitatory current,     -   (ii) in a first mode (e.g., the treatment mode) of the         extracorporeal controller, to wirelessly drive the blocking unit         to apply the blocking current while not driving the excitation         unit to apply the excitatory current,     -   (iii) in a second mode of the extracorporeal controller (e.g.,         the calibration mode), to wirelessly drive the blocking unit to         apply the blocking current while driving the excitation unit to         apply the excitatory current, and     -   (iv) to wirelessly alter a parameter of the blocking current,         based on sensing performed while the extracorporeal controller         is in the second mode. As described hereinabove, for systems 40         and 60, this sensing is performed by sensor unit 26, and the         circuitry automatically receives and responds to it (i.e., to         the sensor signal). For system 160, this sensing is performed by         the subject, who responsively manually operates interface 172,         to which the circuitry responds.

For some applications, the switching between the first and second modes is performed automatically by the circuitry (e.g., according to a calibration routine). That is, for some applications the circuitry automatically periodically switches the extracorporeal controller into the second mode for the calibration routine, and subsequently switches it back into the first mode. For some applications, the circuitry is configured to switch the extracorporeal controller between the first and second modes in response to user operation of the user interface (i.e., calibration is initiated and/or performed manually by the subject or a physician.

During self-checking (e.g., during period 140), the extracorporeal controller may be considered to be in a third mode in which the excitation unit but not the blocking unit is driven.

Reference is again made to FIGS. 1-12. The primary function of each system is blocking of undesirable endogenous action potentials.

Consequently, in a first mode (e.g., a treatment mode) of the system, the blocking current but not the excitatory current is driven. Typically, at least 90 percent of the time that the blocking current is driven, the excitatory current is not driven. In a second mode (e.g., a calibration mode) of the system, both the blocking and excitatory currents are driven, e.g., for the calibration routine. Typically, only during self-checking is the excitatory current driven in the absence of the blocking current. Typically, even for applications in which self-checking is used, more than 30 percent of the time that the excitatory current is driven, the blocking current is also driven. The driving of blocking unit 24 (whether wirelessly by extracorporeal circuitry or wiredly by implant circuitry), is achieved by the circuitry providing a blocking-command signal (which typically powers the blocking unit). This signal has an energy consumption, and the calibration routine of each system is configured to reduce this energy consumption as far as possible. At least because the excitatory current is driven much less (e.g., for shorter periods and/or less frequently) than the blocking current, the extra energy consumption required for the calibration routine is more than offset by the reduction in the energy consumption of the blocking-command signal.

Reference is again made to FIGS. 1-12. The implants described herein are typically injectable, and to facilitate this are typically dimensioned to fit longitudinally through an 8-16 gauge needle (e.g., an 11-14 gauge needle).

It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description. 

1. Apparatus for use with a nerve of a subject, the apparatus comprising: an excitation unit, configured to induce action potentials in the nerve by applying an excitatory current to the nerve; an implantable blocking unit, configured to block the induced action potentials from propagating along the nerve by applying a blocking current to the nerve; an implantable sensor unit, configured to detect the induced action potentials in the nerve, and to responsively provide a sensor signal that conveys information about the detected induced action potentials; and circuitry configured: to drive the excitation unit to apply the excitatory current, to drive the blocking unit to apply the blocking current, while driving the blocking unit to apply the blocking current, to drive the sensor unit to detect the induced action potentials and provide the sensor signal, to receive the sensor signal, and in response to the sensor signal, to alter a parameter of the blocking current.
 2. The apparatus according to claim 1, further comprising an extracorporeal controller that comprises the circuitry, and is configured to wirelessly drive the excitation unit, the blocking unit, and the sensor unit, and to wirelessly receive the sensor signal.
 3. The apparatus according to claim 1, wherein the sensor signal is a wireless sensor signal, and the circuitry is configured to wirelessly receive the sensor signal.
 4. The apparatus according to claim 1, wherein the circuitry is configured to drive the excitation unit wirelessly, and to drive the blocking unit wirelessly.
 5. The apparatus according to claim 1, wherein the excitation unit is configured to elicit paresthesia by applying the excitatory current.
 6. The apparatus according to claim 1, wherein the excitation unit is configured to elicit pain by applying the excitatory current.
 7. The apparatus according to claim 1, wherein the circuitry is configured to automatically periodically run a calibration routine comprising: (a) switching from (i) a first mode in which the circuitry drives the blocking unit to apply the blocking current while not driving the excitation unit to apply the excitatory current, into (ii) a second mode in which the circuitry drives the blocking unit to apply the blocking current while driving the excitation unit to apply the blocking current, (b) while in the second mode, driving the sensor unit to detect the induced action potentials and provide the sensor signal, (c) in response to the sensor signal received in (b), altering the parameter of the blocking current, and (d) switching back into the first mode.
 8. The apparatus according to claim 1, wherein the circuitry is configured: to drive the blocking unit by providing a blocking-command signal having an energy consumption; and in response to the sensor signal conveying information indicative of a reduction of detected induced action potentials, to reduce the energy consumption of the blocking-command signal.
 9. The apparatus according to claim 1, wherein the blocking unit is disposed between the excitation unit and the sensor unit.
 10. The apparatus according to claim 1, wherein the excitation unit is an implantable excitation unit.
 11. The apparatus according to claim 1, wherein the excitatory current has a lower frequency than that of the blocking current, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the lower frequency.
 12. The apparatus according to claim 11, wherein the excitatory current has a frequency of 2-400 Hz, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the frequency of 2-400 Hz.
 13. The apparatus according to claim 12, wherein the excitatory current has a frequency of 5-100 Hz, and the circuitry is configured to drive the excitation unit to apply the excitatory current having the frequency of 5-100 Hz.
 14. The apparatus according to claim 11, wherein the blocking current has a frequency of 1-20 kHz, and the circuitry is configured to drive the blocking unit to apply the blocking current having the frequency of 1-20 kHz.
 15. The apparatus according to claim 14, wherein the blocking current has a frequency of 3-10 kHz, and the circuitry is configured to drive the blocking unit to apply the blocking current having the frequency of 3-10 kHz.
 16. The apparatus according to claim 11, wherein the apparatus comprises an implant that comprises an injectable housing that houses the excitation unit, the blocking unit, and the sensor unit.
 17. The apparatus according to claim 16, further comprising an extracorporeal controller that comprises the circuitry, and is configured to wirelessly drive the excitation unit, the blocking unit, and the sensor unit, and to wirelessly receive the sensor signal.
 18. The apparatus according to claim 16, wherein the housing houses the circuitry.
 19. The apparatus according to claim 16, wherein the housing is dimensioned to be injectable into an epidural space of a subject.
 20. The apparatus according to claim 16, wherein the housing is configured to be implanted at the nerve such that the sensor unit is disposed at a first nerve site, and the blocking unit is disposed at a second nerve site that is efferent to the first nerve site.
 21. The apparatus according to claim 16, wherein: the housing has a longitudinal axis, the blocking unit is 0.5-5 cm along the longitudinal axis from the excitation unit, and the sensor unit is 0.5-5 cm along the longitudinal axis from the blocking unit.
 22. The apparatus according to claim 16, wherein: the housing has (i) a longitudinal axis, (ii) a first half including a first end, and (iii) a second half including a second end, and is injectable into the subject along the longitudinal axis, the excitation unit comprises an excitation electrode disposed on the housing within the first half; and the blocking unit comprises a blocking electrode disposed on the housing within the second half. 